Vomiting: causes, what to do and when to get care

Vomiting is forcefully bringing up what is in your stomach through your mouth. It is a protective reflex: it happens when something irritates the stomach or when the brain gets a signal that something is wrong. It is a symptom, not a disease, and what matters is finding the cause and keeping you from getting dehydrated.

If you only feel the urge to vomit without actually doing it, see nausea. If vomiting comes with diarrhea, see stomach bug. This page helps you decide what to do today and when not to wait.

According to MedlinePlus, the most frequent causes in adults are:

• A stomach virus (gastroenteritis) or food poisoning, sometimes with diarrhea and fever: see stomach bug
• Traveler's diarrhea if you traveled or ate something unusual: see traveler's diarrhea
• Eating reef fish (ciguatera), with vomiting hours later and then tingling: see ciguatera
• Reflux or gastritis: see gastritis
• Migraine, which can bring vomiting with the headache: see migraine
• Motion sickness on a boat, a cruise or in the car: see seasickness
• Medicines, such as chemotherapy or GLP-1 medicines for diabetes or weight
• Pregnancy (morning sickness)
• Severe pain, for example from a kidney stone or a gallbladder or appendix problem: see stomach pain
• Frequent marijuana use, heavy drinking, or a food allergy

First, do not force anything. Let your stomach rest for a while and, once the urge to vomit passes, start with small sips of clear liquids often: water, oral rehydration solution, broth. A sip or a teaspoon every few minutes stays down better than a whole glass at once. If it stays down, increase the amount little by little.

Once liquids stay down, move to bland, simple foods in small portions, and for a while avoid anything very greasy, very sweet or spicy, alcohol and coffee. You do not need to fast for days: your body needs energy and fluid.

In Puerto Rico’s heat, vomiting can dehydrate you quickly. See dehydration to recognize the signs: dry mouth, more thirst, urinating little or dark yellow urine, dizziness when you stand, sunken eyes. Do not take leftover anti-nausea medicine or someone else’s: which one is safe depends on the cause, your age, your heart and whether you could be pregnant.

Most viral vomiting passes on its own. The real risk is rarely the vomiting itself but losing more fluid than you can drink. That is more likely if you also have diarrhea, fever or a lot of heat, and it is more delicate in young children, older adults, pregnant women, and people with diabetes or kidney or heart disease.

Get medical care right away if you have gone 8 hours or more without urinating, have a very dry mouth and tongue, strong dizziness when standing, a very fast heartbeat, great drowsiness or confusion. In a baby or child, look for crying without tears, a sunken soft spot, being very limp, or refusing to drink anything.

Children dehydrate faster than adults. Give small amounts of fluid often (oral rehydration solution, by the teaspoon or with a needleless syringe if very small) and do not wait if there is no urine, they vomit everything they drink, have a high fever, are very sleepy, or vomit green (bile) or blood. Forceful, projectile vomiting in a very young baby also needs prompt medical attention; if it is severe or the baby seems limp, go to the emergency room.

If your child has vomiting and diarrhea together, see diarrhea and vomiting in children. If the vomiting started after a blow to the head, do not treat it at home: go to the ER.

Nausea and vomiting are common early in pregnancy. If there is any chance you could be pregnant, take a drugstore pregnancy test and see pregnancy symptoms. According to MedlinePlus, call your OB or go to the ER if you cannot keep any fluids down for 12 hours, vomit blood, have belly pain, dizziness, dark urine or other signs of dehydration, or have lost more than 5 pounds. That may be hyperemesis gravidarum and needs care.

You see Dr. Diana Nieves Castro, a Puerto Rico-licensed general practice physician with several years of emergency-department experience, in English or Spanish. She asks how long you have been vomiting and how often, what the vomit looks like, whether you have diarrhea, fever or pain, what you ate, whether you traveled, which medicines you take, whether you hit your head and whether you could be pregnant. She also looks for signs of dehydration that show on camera.

We evaluate, diagnose and treat. If the cause is a stomach virus or another treatable cause, the doctor explains how to rehydrate and, if appropriate, prescribes a medicine for the vomiting or its cause, and we send your prescription to your pharmacy. If needed, we give you a lab order for a lab near you, for example electrolytes, kidney or liver tests, or a urine test. If she sees warning signs, she tells you clearly and sends you to the ER.

An online doctor visit has the same price for every age and can be used for you or your child. If the patient is under 21, a parent or legal guardian stays on camera for the whole visit and shows ID. Video doctor visits 24/7: book online and choose your time right away.

According to MedlinePlus, call 911 or go to the ER if you think the vomiting is from a poison or a substance, or if you see blood or dark material like coffee grounds in the vomit. Get medical care right away if:

• You have severe stomach or belly pain, or your belly becomes hard
• You have a bad headache, a stiff neck or confusion
• You vomited after a blow to the head
• You have chest pain or pressure, or shortness of breath: call 911
• You have been vomiting for more than 24 hours, or can’t keep fluids down for 12 hours or more
• You vomited 3 or more times in a day, or haven’t urinated for 8 hours or more
• You are pregnant and can’t keep fluids down, or you vomit blood
• You have diabetes and can’t keep fluids or food down
• You are very drowsy or confused, or the vomit is green or bloody